Soft Tissue Infections

Question 1

Identify

Answer 1

sporothrix schenckii

rose gardeners disease

Question 2

infection of the dermis and subcutaneous tissue

Answer 2

Cellulitis

Question 3

superficial skin infection involving the upper dermis with clear
demarcation between involved and uninvolved skin with prominent lymphatic involvement

Answer 3

Erysipelas

Question 4

formed by multiple interconnecting furuncles that drain through several openings in the skin

Answer 4

Carbuncles

Question 5

single, deep nodules involving the hair follicle that are
often suppurative

Answer 5

Furuncles

Question 6

collections of pus within the dermis and deeper skin tissues, potentially involving the subcutaneous tissues

Answer 6

Skin abscesses

Question 7

microbial triggered necrosis involving any of the soft tissue layers including the dermis, subcutaneous tissues, fascia, and muscle

Answer 7

Necrotizing soft tissue infections

Question 8

True or false

General Risk Factors for Cellulitis and Erysipelas include: Hypogammaglobulinemia
Obesity
Chronic renal disease
Cirrhosis

Answer 8

True

Question 9

Fish tank exposure is risk for what organism?

Answer 9

Mycobacterium marinum

Question 10

hot tub exposure is risk for?

Answer 10

Pseudomonas aeruginosa

Question 11

Salt water lacerations

Answer 11

Vibrio vulnificus
Vibrio parahaemolyticus

Question 12

Fresh water lacerations

Answer 12

Aeromonas hydrophila

Question 13

cirrhosis is risk factor for what org.?

Answer 13

Vibrio vulnificus
Vibrio parahaemolyticus

Gram-negative bacteria

Question 14

Nonimmunized children and adults

Answer 14

Streptococcus pneumoniae and
Haemophilus influenzae

Question 15

injection drug use is risk for

Answer 15

Pseudomonas aeruginosa

Question 16

Contact sports

Answer 16

MRSA

Question 17

Hemodialysis risk for

Answer 17

MRSA

Question 18

causative agent in purulent cellulitis

Answer 18

MRSA

Question 19

For nonpurulent cellulitis causative agent

Answer 19

β-hemolytic streptococcal

Question 20

What is impairment of lymphatic drainage, permanent swelling, dermal fibrosis, and epidermal
thickening or chronic changes due to recurrent cellulitis

Answer 20

elephantiasis nostra

Question 21

True or false

Complete involvement of the ear is the “Milian ear sign” and is a distinguishing feature of erysipelas because the ear does not contain deeper dermis tissue typically involved in cellulitis

Answer 21

True

Question 22

Lymphatic inflammatory change in erysipelas

Answer 22

toxic striations

Question 23

True or false

wound culture is recommend when the decision has been made to place the patient on antibiotics for purulent cellulitis

Answer 23

True

Question 24

POCUS is useful in cellulitis to

Answer 24

exclude occult abscess

Question 25

Doppler studies may be indicated in cellulitis to

Answer 25

distinguish lower extremity deep venous thrombosis from
cellulitis

Question 26

most important diagnosis to exclude is

Answer 26

necrotizing soft tissue infection

Question 27

Differentiate Necrotizing soft tissue infection vs cellulitis

Answer 27

Rapid progression; triad of severe pain, swelling, and
fever; pain out of proportion to exam; severe toxicity;
hemorrhagic or bluish bullae; gas or crepitus; skin necrosis
or extensive ecchymosis

Question 28

Empiric Treatment of Nonpurulent Cellulitis*/Erysipelas for mild diseas

Answer 28

Cephalexin 500 milligrams PO every 6 h†
Or dicloxacillin 500 milligrams PO every 6 h†
Or clindamycin 150–450 milligrams PO every 6 h†

Question 29

Empiric Treatment of Nonpurulent Cellulitis*/Erysipelas antibiotics for moderate disease

Answer 29

Ceftriaxone 1 gram IV every 24 h†
Or cefazolin 1 gram every 8 h†
Or clindamycin 600 milligrams IV every 8 h

Question 30

Empiric Treatment of Nonpurulent Cellulitis*/Erysipelas

for severe disease

Answer 30

Vancomycin 15 milligrams/kg IV every 12 h†
Plus piperacillin-tazobactam, 4.5 grams IV every 6 h†
Or meropenem, 500–1000 milligrams IV every 8 h†
Or imipenem-cilastatin, 500 milligrams IV every 6 h†

Question 31

Antibiotics Fresh water exposure

Answer 31

Doxycycline 100 milligrams IV every 12 h

Plus ciprofloxacin 500 milligrams IV every 12 h†

Question 32

Antibiotics Salt water exposure (suspected Vibrio species)

Answer 32

Doxycycline 100 milligrams IV every 12 h†
Plus ceftriaxone 1 gram every 24 h†

Question 33

Antibiotics Suspected Clostridium species:

Answer 33

Clindamycin 600–900 milligrams IV every 8 h†

Plus penicillin 2–4 million units IV every 4 h†

Question 34

Type I

Answer 34

polymicrobial

gram-positive cocci, gram-negative rods, and anaerobes

Question 35

Type II

Answer 35

monomicrobial

group A Streptococcus

Question 36

type III

Answer 36

Vibrio vulnificus

Question 37

Type IV

Answer 37

fungal

F our F ungal

Question 38

“hard” signs of necrotizing fasciitis

Answer 38

Solid:
skin necrosis

Liquid:
bullae,
hypotension, or

Gas:
crepitus
gas on radiograph

Question 39

True or false

In nec fas, antibiotics alone are rarely effective, and imme-
diate surgical consultation and intervention remain the cornerstone of successful management

Answer 39

True

Question 40

the gold standard for diagnosis and treatment in necrotizing skin infections

Answer 40

Surgery

Question 41

Mortality skyrockets if debridement
is delayed

Answer 41

> 24 hours